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Head Injury

Serious head injuries are unusual in helmeted bikers. This means head injury is more common among pre-teens, although there are plenty of adults who think they don't need a helmet because they'll never fall down. Also, adults usually fall forward, where their hands can absorb and control the landing to help protect the head. Kids are much more likely than adults to fall backwards, which makes head injury much more likely.

Mountain biking head injury can range from a simple goose-egg to instant death due to massive brain injury. It all depends on the momentum of the head (the speed with which it hits) and the hardness of the object it lands on (rock versus sand). You don't need to injure the scalp to cause brain injury: if the helmeted head is traveling fast enough when it stops, the brain will slosh against the inside of the skull.

See the doctor if:
    - loss of consciousness occurred
    - there is confusion or poor memory
    - there is severe headache
    - there are any deficits: change in vision, one-sided loss of hearing, etc
    - there is repeated vomiting

Initial management:
Scalp lacerations can bleed profusely. Put direct pressure on the laceration (ideally with sterile dressing material, but your bike shirt will do). If continued pressure is needed, tie the cloth into place with a sling (triangular bandage). You may be able to maintain pressure by cinching your bike helmet snugly over a cloth compress.

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Rest. Cold pack the tender area. Take only clear liquids for the first eight hours. Take acetaminophen for pain. Do not take any medication that may alter your level of alertness. (Avoid taking narcotic pain relievers such as Tylenol#3 and Lortab!) Limit activity for the first 24 hours. Several times during the first 24 hours, check to see if the pupils are equal in size and that the patient is alert (or rouses easily) and responds normally.

Watch for:
    - persistent or projectile vomiting
    - unequal pupil size
    - difficulty in arousing the patient
    - worsening or continued headache
    - severe dizziness
    - failure to improve as expected.

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